What are the plan benefits?
The following information is a brief overview of the Plan benefits. Additional information regarding eligibility for coverage, eligible expenses and limitations and exclusions is available on other pages. For complete plan details, please refer to the Certificate of Insurance that will be issued to you upon enrollment or you may request a sample. Request Assistance
Deductible: The Allied™ Short Term Medical Plus plan offers 7 deductible options to suit your needs: $500, $1,000, $1,500, $2,500, $5,000, $7,500 or $10,000. This is a one-time deductible during your coverage period. If you are covering dependents there is a maximum of three deductibles per family.
Coinsurance: There are two coinsurance levels available depending on deductible selected:
For deductibles of $2,500 and less, following satisfaction of your deductible, the Plan pays 80% of the first $10,000 of eligible expenses and 100% of eligible expenses in excess of $10,000 for a total out-of-pocket expense of $2,000 (not including your deductible).
For a $5,000, $7,500 or $10,000 deductible, following satisfaction of your deductible, the plan pays 100% of eligible expenses.
$500 Supplemental Accident Benefit option:
If you elect this benefit option, $500 of benefit will be paid for covered charges due to an accident before your deductible and coinsurance begin.
Maximum Benefit: The Allied™ Short Term Medical Plus plan pays a maximum benefit of $250,000 for each insured person while insured.
Benefit Period: The Allied™ Short Term Medical Plus plan is available for benefit periods up to 3 months as selected at enrollment.
Important Note: Short-term medical products do not meet the Affordable Care Act’s definition of minimal
essential coverage and therefore do not fulfill an individual’s requirement to maintain coverage.
What are the covered expenses and benefit maximums?
Most medical services, including physician care, Inpatient
and Outpatient hospital services, laboratory testing and
surgical services are covered by the Allied™ Short Term Medical PLUS plan. The items listed below are specific exclusions, limitations or benefit maximums.
There are additional limitations and exclusions contained in the policy.These may be found on the Limitations and Exclusions page. You will be issued a detailed Certificate
of Insurance which you should review thoroughly.
Coverage may be cancelled by the insured and premium
refunded if requested within 10 days of receiving the
Certificate of Insurance.
Eligible Expense is the Maximum Allowable Charge for
the following services. Benefits for some covered expenses may vary according to state law and benefit plan
Lifetime Maximum Benefit per Human Organ or Tissue Transplant:
$250,000. Human Organ or Tissue Transplant from a
Hospice Care (other than inpatient) Maximum Benefit: $2,000
Coverage Period Home Health Care Maximum Benefit: 40 Visits
Air Ambulance–transportation per trip: Maximum Benefit $750
Durable Medical Equipment Rental Maximum Benefit: $250
(not to exceed purchase price)
Coverage Period Maximum Benefit for Intercollegiate Athletic
Bodily Injuries for injuries sustained while training, practicing,
undergoing conditioning or physically preparing for, or participating
in, any school sponsored intercollegiate, interscholastic or
other secondary or post-secondary interschool athletic or sports
event, contest or competition: $10,000
Coverage Period Maximum Aggregate Benefit (except as otherwise indicated in the Schedule of Benefits) for
any Dependent added to the Policy after the Policy Effective Date: $100,000.00
In addition to the above limitations, the Certificate of
Insurance contains additional exclusions and limitations
that should be reviewed upon receipt. In brief, the Plan
does not cover pre-existing conditions; work related
injuries; pregnancy; injuries due to war, commission of a
crime or while intoxicated/taking a controlled substance;
cosmetic surgery; elective treatments; treatment of teeth;
TMJ; eyesight correction; treatment of obesity; artificial
eyes or limbs; reventive services; treatment outside the
United States; treatment that is not medically necessary;
non-emergency treatment of hernias, tonsils/adenoids or
gall bladder; treatment of growth disorders or developmental
delay; Kidney or end stage renal disease; injuries
sustained while participating in certain sporting or recreation
activities; treatment of AIDS or ARC; treatment or
diagnosis of allergies and headaches; treatment of Mental,
Nervous & Emotional disorders; and certain services
related to the treatment of diabetes.
See Certificate of Insurance for complete details. This is a only a limited description of the Plan. Exact provisions of the plan are contained in the Policy issued to the policyholder. Some provisions, benefits, exclusions & limitations mary vary depending on your state of residence.